On twitter this past weekend, I saw a tweet that commented on the fact that there were too few black men who became doctors. I readily confess that I don’t know the reason why. I asked whether it is due to implicit bias or outright racism. Another doctor answered that both play a role. Although I have witnessed acts of racism and bias in the past, I can’t say I understand it very well being a white woman. However, one only needs to look around and see the truth that there are too few minority doctors, both men and women.
Why are there are too few minorities who become physicians?
- Someone answered and suggested that it is due to lack of interest and lack of appropriate role models. It was postulated that black youth look up to rap stars and athletes. Well, so do white people. I’ve always been a big rock n’roll fan and a follower of professional sports. My childhood idol was Tug McGraw, relief pitcher for the Philadelphia Phillies. I was also an exceptional track and cross-country runner and went to college on an athletic scholarship. Yet, I was still able to follow my dream to become a doctor, even with other outside interests. I think this theory clearly misses the fact that humans are diverse and can have many interests.
- Lack of mentors. A mentor is someone who can help pull someone up the career chain. It is always helpful to have a mentor. One physician commented that the only ones who ever mentored him were black as well. When we acknowledge the fact of lack of minorities, especially in leadership roles, it is very easy to see the struggle a minority has to do to pull himself/herself up the ladder. This definitely contributes to the problem, but it is not the problem. Why should it be harder for a minority student to find a mentor than someone who is not a minority? This is a question every physician should be asking themselves and should include in the answer what they are planning to do to change it.
- The most qualified get accepted/promoted. Everyone needs to put away the concept of affirmative action. I have actually witnessed another physician telling a black physician that he got accepted into a program because of affirmative action. If that thought has ever crossed your mind, just stop. There are many very qualified, maybe more so than their white counterparts, black individuals who are never given the same opportunities to become physicians or advance into leadership positions. If we look at the leaders and decision-makers in medicine, it is a greatly white and male majority. Is it because of unperceived bias? I can’t answer this question but I think institutions need to address the fact that there are not enough minorities going into medicine.
- Tokenism is not the same as inclusion. For the sake of looking unbiased and diverse, many committees and institutions will have a lone minority and/or women on their roster. This, however, is mere tokenism. It does nothing to bolster true equality or diversity. Only when committees and institutions mirror everyone can we say they are inclusive. A minority needs to feel they are part of the system, not merely represented because one person was allowed to stand in for them. We need real diversity and not the image of it.
- Lack of leaders. In the work I do on gender equity, many claim women don’t want to be leaders or are not qualified for leadership roles. This is wrong for women and for minorities as well. They are often not given the chance to show their leadership skills. Those now in leadership roles, no matter their cultural heritage, need to actively search for those who are qualified and under-represented to fill the chairs at the head of the table. Antiquated opinions as to who is qualified or who has the desire need to be thrown out. Stop assuming people’s thoughts. Ask them, find them.
We all need to care about racism and bias in healthcare. Not only is it a social injustice that people are excluded, purposely or unintentionally, from any pursuit just based of the color of their skin or cultural background, but it affects patient outcomes. Many studies bear out the fact that black women have worse clinical outcomes for certain diseases, such as breast cancer, than their white counterparts. If you don’t care about being socially sound, you must care about clinical outcomes of patients if you work in the healthcare setting.
As for me, I do care. Real racial diversity must happen in medicine. As long as any one feels excluded or gets left behind because of the color of their skin, cultural heritage, gender, etc, we are all to blame. We don’t need to belong to the minority group to speak out. Unless we all do, it will never change. It is unconscionable that racism exists in medicine in the 21st century. I may not bear witness to it every day, but I know it is there as I’m sure all of you who read this do. What can be done to change it? For me, any student who learns from me will be given every opportunity to learn that I have available. If they need a mentor, I will be what they need, regardless of what they look like or where they came from. And I will keep speaking out until we no longer need to have a conversation that includes the terms “women doctor” or “black physician”, but rather we are all just doctors. What will you do?
Copyright secured by Digiprove © 2019 Linda Girgis, MD, FAAFP
The reasons are probably many. I think the physician community, and the medical school deans in particular, are sensitive to this reality and struggle to achieve the diversity of their classes without compromising the competitive nature of the admissions process. As a product of the 1970’s, my dean was very upfront about an affirmative action pool for admissions. Tutoring given but no accommodation on exams or clinical performance. A few dropped out, two were dismissed and the others became physicians, one at least, a woman, a very prominent distinguished one. My contemporaries are now at the close of their careers, not only at my school but at the other 100+. How did they fare as practitioners? There are ways to find out. I have a class list given to me by the alumni association. Most of us are in practice, or were. Did this effort of forty years ago change access to medical care of citizens of color? Not nearly as much as defraying medical school costs for American graduates or HB-1 visas with service requirements did.
Are the African-American men in college taking Organic Chemistry and achieving an A or B, or are they diverted to the security of computer sciences programs or the pre-law options that do not require arduous lab courses and intense competition for those high grades? The one thing that American medical schools cannot do is waive the required courses, and they created some pretty hairy exam weeks.
As for mentors or role models, we are around, though not always effective. My wife’s major advisor eventually got a Nobel Prize but was of no help in planning her chemistry career. I had an assigned pre-med advisor who looked at my grades and gave me a list of schools that might accept me but no career guidance. It is one thing to assign advisors, quite another to make them accountable. Basically senior people are generally of good will. I’ve never been turned away when I sought a professor or attending’s guidance and never turned away anyone seeking mine. But the process is too random and inconsistent to be applied in a widespread way. As a recently retired person, my medical and person blogs have vignettes about people who shaped me, often written as I learn of their passing. But with one exception, I came to them, they did not come to me.
I think the sensitivity of the medical community to health and provider disparities is very much on the front burner, so much so that my own professional organization made it the theme of a recent Annual Meeting. Unfortunately, for a profession gets its best results when data driven, we are still basicaly speculating on how to address the undesirable reality that we have.
Enjoy your retirement at what age did you retire?